<p> The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health Bureau of Health Care Safety and Quality 99 Chauncy Street, 11th Floor Boston, MA 02111</p><p>Tel: 617-753-8000 DEVAL L. PATRICK www.mass.gov/dph GOVERNOR JOHN W. POLANOWICZ SECRETARY CHERYL BARTLETT, RN OMMISSIONER</p><p>Circular Letter DHCQ: 13-9-597</p><p>To: Administrators, Director of Nurses and MDS Coordinators of Medicare/Medicaid Certified Skilled Nursing and Nursing Facilities</p><p>From: Madeleine Biondolillo, MD Interim Associate Commissioner, DPH Paul DiNatale, MA., MSW Assistant Director Health Care Quality</p><p>Re: Additional Section S questions effective 10/1/2013: Unnecessary use of Antipsychotic Medications </p><p>Date: September 9, 2013</p><p>This circular letter is to inform Massachusetts Medicare and Medicaid Certified Long Term Care Facilities that Massachusetts is adding five questions to the Minimum Data Set (MDS) section S regarding use of Antipsychotic Medications. Effective 10/1/2013 Medicare and Medicaid certified facilities will be required to complete the questions per the directions attached. </p><p>Background: The Centers for Medicare and Medicaid (CMS) established the goal in 2012 of reducing the use of unnecessary antipsychotic medications. CMS recently released data relative to the national year end result. The providers in Massachusetts have made a significant impact in reducing the number of residents on unnecessary antipsychotic medications. In fact, there has been an 8.2% reduction in the use of antipsychotic medications since the baseline fourth quarter of 20111. This success means fewer residents in Massachusetts SNF/NFs are now receiving unnecessary antipsychotic medications. We look forward to continuing the effort at improving care for all residents as we seek to increasingly use non-pharmacological interventions based on resident-centered care principles.</p><p>MDS New Section S Questions: The Department at the suggestion of the Massachusetts Collaborative for Resident-Centered Care has added questions to the MDS section S to better understand and document the work Massachusetts facilities are doing to reduce the use of antipsychotic medications</p><p>1 The use of antipsychotic medications in Massachusetts was 26.67% in the fourth quarter of 2011 compared to 24.49% in the fourth quarter of 2012. This is a 2.18% point change with an 8.2% reduction in usage. The standard data collected in the MDS for antipsychotic medication use identifies residents who are and are not receiving antipsychotic medications, but does not capture dose reductions which may occur as part of the facility’s efforts to reduce the use of such medications. While the goal is to discontinue the use of antipsychotic medication where it is clinically appropriate, it is understood that this may not be achieved for all residents, however, as clinical staff assess each resident, there may be successes achieved in medication dose reductions. The new section S questions will provide a facility the opportunity to document this effort. </p><p>The MDS Section S will include five questions S6230, S6232, S6234, S6236 and S2060. These five questions query the use, dose reduction, discontinuance of Unnecessary Antipsychotic Medication. In addition, many facilities are employing non-pharmacological approaches to achieve a reduction in the use of antipsychotic medications. Question number S2060 will capture the programs facilities are employing.</p><p>The MDS Section S questions are detailed in the attached completion guide.</p><p>If you have any questions regarding these please contact the MDS clinical coordinator Pamela Melideo, RN at 1-617-753-8047. Note: For automation questions please contact the MDS automation coordinator, Andrew Sinatra at 1-617-753-8122.</p><p>Attachment: Section S Completion Guidance Manual</p><p>2</p>